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Physician Suicide Chat

Every year, approximately 400 U.S.-based physicians commit suicide, the equivalent of an entire medical school.

This issue is of major concern to Medscape readers. In fact, a recent Medscape Perspective article on physician suicide garnered over 800 comments. The American Psychiatric Association along with suicide expert Dr. Michael Myers will participate in this chat and answer your questions.

Jenna again - so true - for too long not enough emphasis has been given to our family and personal lives - this is archaic thinking back to the days when most docs were men who had traditional marriages.

Erin - not sure - what we do know is that too often suicide attempts by doctors are lethal because of the research suicidal docs do to make sure they die. This is frightening but I have heard it over and over again in my office. "I don't want to blow it - I've seen too many botched attempts"

Hello-- thanks so much for putting this chat together. What is the best way to study this problem? I feel that physician suicides don't happen that often (maybe once every couple years at a large institution)-- then afterwards, mostly no one wants to discuss it. Families may not either, because it is so painful, and perhaps they don't want their loved one to be remembered that way.

I am a psychiatry resident in Los Angeles area where it is considered far more "relaxed" than on the east coast. However, it is amazing that my program is so unsupportive of people with physical/mental illness. I have watched other residents (and myself) struggle with depression and other physical illnesses without support from our program but instead facing discipline or scolding for missing work. I was even scolded when I was so sick that I was in the hospital. How can we change this environment as upcoming leaders in the medical world when many of our current leaders oppress us?

It's possible that the higher suicide rate among doctors could be a result of their higher completion to attempt ratio, which likely stems from a greater knowledge of the lethality of drugs and easier access to other means of suicide than the general population.

Amy - yes, but the fallout is horrendous. So many people are affected - family, medical colleagues, patients, friends, teachers, students, treating professionals and more. Yes, people do move on but it stays in the back of their minds - we all struggle with guilt and powerlessness.

Can you address the question of stigma and barriers to seeking care-- as physicians, everyone has rotated on Psychiatry. This is an educated group of people who have had exposure to the mental health system. But some do not ever seek help. What can we do about this? Make it easier to seek care? How might we address stigma among physicians?

I think doctors' attitudes about psychiatry begin to be shaped in med. school and residency. How is the field perceived of by trainees who aren't planning to go into Psychiatry? If they have a negative impression or are learning about stigma by senior colleagues, that doesn't bode well for reaching out for care later if they need it!!!

Stigma is enemy number one! This cuts across all specialties and can be even worse in psychiatrists. There is much internalized stigma in psychiatrists, like we're supposed to be immune. But as we all know, some oncologists get cancer or cardiologists have MIs

Yes, not to get lost in all of this. Remember that 85-90% of all people who die by suicide have an underlying psychiatric illness. This includes us - especially depression, substance use disorders, severe anxieity disordesr and unrelenting burnout!

Advice to medical students - take care of yourself, make use of resources on campus, meditate, exercise, do yoga, keep non medical friends, fight for balance in your life, watch your alcohol intake and by all means go to campus counselor if you're not feeling well. There is no shame in that.

Because of shame and stigma, many docs do self-medicate. I get calls like this and they ask me to take over their care which is great. However, many docs have trouble following doctors' orders and they fiddle with their meds. This can be dangerous leading to relapse and recurrence of symptoms.

Dr. Myers it seems like stigma plays a big part in the decision not to get treatment. According to this article from The Atlantic, only about half of depressed interns that took part in a study obtained mental health services.

As providers we should be able to discuss our frustrations and failures without the worry of being negatively viewed or that our licensing board would be notified. Being able to voice our frustrations is sometimes all that is needed, it doesn't mean that "one is on the edge" of ending life

This is a real problem-- anecdotally I can share that we just had our 20th high school reunion, and the 2nd doctor in our class just committed suicide couple months ago. These were the top students in our class, it was a competitive high school. Very accomplished person at an academic institution, leaves behind a family. I wish there were a way to learn from these situations, but obviously the subject is very touchy, makes it difficult to learn from.

Re Atlantic article, yes, stigma is huge. However, some docs also report that they don't have time to go to their psychiatrist or therapist because of long working days. So we need services in the evenings and weekends - or give our trainees time off to take care of themselves!!

Amy - so sorry - competition is another risk factor in our training environments. I wonder if we should eliminate the awards that we give every year and replace them with an award for the doctor who lives a balanced life or has the happiest family? Not kidding here.

Thank you for that last point Dr. Myers. Perhaps M.D. suicide is, in some cases, a "perfect storm"; mental illness is common, even amongst physicians, as you point out. But then you add perhaps a certain perfectionistic personality style, a stressful career issue that arises, stigma....a lethal combination.

I think most all the previously mentioned factors play a role. But it seems to me that more study is needed on other factors, possibly a 'reactivity' factor - having to do with inability to accept criticism, discipline, public scrutiny -- not exactly stigma but related.

I agree stigma is enemy #1. How do we move from a medical culture where medical students, residents, and physicians in practice feel the need to compete with one another to a more collaborative and supportive community where physicians develop connections with each other and the cycle of isolation, burnout, etc is prevented?

Robert Miday - yes - we are human and not everyone has thick skin - that's a given - without compromising training and learning, we do need to be aware that sometimes teaching methods can be very hurtful and dangerous, in vulnerable individuals.

I spoke with Dr. Myers before the chat and he said if you are worried about a colleagues mental health--by all means, do something. It is not acceptable to turn the other cheek or leave it to someone else. Try to find out if others are worried or have noticed anything amiss. If so, compile a composite of concerns without disclosing anyone’s identity. Also--approach your colleague on a one-on-one. Find a private place to meet.